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General NPI Number Information
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NPI Number | 1912427295
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Entity Type | Organization
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Legal Business Name | G.GARY GREEN DMD, PA INC
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 277 BLOOMFIELD AVE
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City | CALDWELL
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State | NJ
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Zip | 07006-5104
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Country | US
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Telephone | 973-228-0252
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Fax | 973-228-0918
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Provider Business Mailing Address
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Address Line | 277 BLOOMFIELD AVE
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City | CALDWELL
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State | NJ
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Zip | 07006-5104
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Country | US
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Telephone | 973-228-0252
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Fax | 973-228-0918
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Authorized Official
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Title or Position | PERESIDENT/OWNER
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Name | DR. GAIL GARY GREEN JR.
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Credential | DMD
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Telephone | 973-228-0252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 12168
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License Number State | NJ
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